Bonner Alexandra, Boyle Jacqueline
Department of O&G, Royal Darwin Hospital, Tiwi, Northern Territory, 0810, Australia.
Monash Centre for Health Research and Implementation - MCHRI, Women's Public Health Research, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, 3168, Australia.
Aust N Z J Obstet Gynaecol. 2017 Jun;57(3):351-357. doi: 10.1111/ajo.12601. Epub 2017 Apr 10.
Urinary incontinence (UI) is likely to be high in Aboriginal women in rural Australia due to risk factors including high body mass index, parity and diabetes. However, UI appears to be under-reported with limited information on whether women access appropriate care.
To assess whether women who access specialist gynaecological services in rural and remote Top End Northern Territory (NT) through the specialist outreach program (SONT) are receiving care for UI aligned with best practice.
Review of all 1426 SONT referrals in 2012, with audit of management for those women referred for UI or prolapse.
Of 1426 SONT referrals, there were 43/1426 (3%) women referred for UI, with 34/43 (79%) attending. Of those referred, 31/43 (72%) were Aboriginal. Of twenty-six women diagnosed with probable stress UI, less than a fifth, 5/26 (19%), were referred to physiotherapy, with 2/5 (40%) attending appointments. Referral occurred for 14/23 (61%) of those suitable for urodynamics but only 6/14 (43%) attended. Just under half of women 7/16 (14%) with stress UI were referred for surgery, with 6/7 (86%) attending.
In rural and remote Top End NT, specialist health service management of female UI could be improved by increased provision of current best-practice and an integrated multi-disciplinary team approach with allied health. Under-reporting and under-referral for female UI could be addressed by increasing awareness among community and primary healthcare providers of the problem of female UI and the conservative, medical and surgical treatments available.
由于包括高体重指数、多产和糖尿病等风险因素，澳大利亚农村地区的原住民女性尿失禁（UI）发生率可能较高。然而，尿失禁似乎报告不足，关于女性是否获得适当护理的信息有限。
评估通过专科外展项目（SONT）在北领地偏远顶端地区农村获得专科妇科服务的女性是否接受了符合最佳实践的尿失禁护理。
回顾2012年所有1426例SONT转诊病例，并对因尿失禁或子宫脱垂转诊的女性的管理情况进行审核。
在1426例SONT转诊病例中，有43/1426（3%）的女性因尿失禁转诊，其中34/43（79%）前来就诊。在这些转诊患者中，31/43（72%）为原住民。在26例被诊断为可能的压力性尿失禁的女性中，不到五分之一，即5/26（19%）被转诊至物理治疗，其中2/5（40%）前来预约。适合进行尿动力学检查的患者中有14/23（61%）被转诊，但只有6/14（43%）前来就诊。压力性尿失禁女性中近一半，即7/16（14%）被转诊进行手术，其中6/7（86%）前来就诊。
在北领地偏远顶端地区农村，通过增加当前最佳实践的提供以及采用与联合健康相关的综合多学科团队方法，可以改善女性尿失禁的专科医疗服务管理。通过提高社区和初级医疗保健提供者对女性尿失禁问题以及可用的保守、药物和手术治疗方法的认识，可以解决女性尿失禁报告不足和转诊不足的问题。
